DOCSLIB.ORG

Utah Medicaid Dur Report January 2021 Long-Acting

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Utah Medicaid Dur Report January 2021 Long-Acting UTAH MEDICAID DUR REPORT JANUARY 2021 LONG-ACTING INJECTABLE & ORALLY DISINTEGRATING SECOND GENERATION ANTIPSYCHOTICS Report Finalized in December 2020 Report Presented in January 2021 Drug Regimen Review Center Valerie Gonzales, Pharm.D., Clinical Pharmacist Lauren Heath, Pharm.D., MS, BCACP, Assistant Professor Vicki Frydrych, B.Pharm., Pharm.D., Clinical Pharmacist Joanne LaFleur, PharmD, MSPH, Associate Professor University of Utah College of Pharmacy Copyright © 2021 by University of Utah College of Pharmacy Salt Lake City, Utah. All rights reserved 1 | Page Contents Introduction ............................................................................................................................................................ 4 Table 1. Long-Acting Injectable SGAs, FDA Indicated Disorders ........................................... 4 Table 2. ODT Antipsychotics, FDA Indicated Disorders ............................................................ 5 Methods .................................................................................................................................................................... 5 A. Long-Acting, Injectable Second-Generation Antipsychotics ........................................................ 6 Diagram 1. Administration Frequency for LAI Products .......................................................... 7 Administration of early doses ................................................................................................................. 8 A.1. Concomitant Use of LAI and Oral Antipsychotics ........................................................................ 8 When initiating LAI antipsychotics ....................................................................................................... 8 If a missed dose occurs .............................................................................................................................. 9 When metabolism modifiers are prescribed ..................................................................................... 9 Management of Breakthrough Psychosis ........................................................................................ 10 A.2. Additional Tables and Considerations for LAI Products ....................................................... 11 Switching from Other LAIs .................................................................................................................... 11 Table 3. Product Prescribing Information Regarding Switching Therapies .................. 11 Unique Safety Warnings for SGA LAIs ............................................................................................... 12 Table 4. Second Generation, LAI Antipsychotics and Labeled Dosing ............................. 13 Table 5. Pharmacokinetics for LAI SGAs ...................................................................................... 15 A.3. Place in Therapy .................................................................................................................................... 17 Overview of Potential Advantages and Disadvantages of LAI Antipsychotics .................. 17 Place in Therapy per Clinical Guidelines .......................................................................................... 18 For Schizophrenia ................................................................................................................................. 18 For Bipolar I Disorder ......................................................................................................................... 19 Pediatric Use ............................................................................................................................................... 19 B. ODT Products .............................................................................................................................................. 20 B.1. ODT Product Description ................................................................................................................... 20 Table 6. ODT Second Generation Antipsychotics, Approved Indications ...................... 20 Table 7. ODT Product Pharmacokinetic Information ............................................................. 21 B.2. Place in Therapy for ODT Products ................................................................................................ 22 Adherence or Compliance ...................................................................................................................... 22 2 | Page Further Information Regarding Rapid Mitigation of Acute Agitation/Aggression Associated with Various Psychiatric Disorders ............................................................................. 23 Prior Authorization (PA) Considerations ................................................................................................. 25 Summary ............................................................................................................................................................... 27 References ............................................................................................................................................................ 28 Appendix A: Literature Searches ................................................................................................................. 32 Appendix B: Treatment Guidelines Addressing Rapid Mitigation of Acute Agitation/Aggression ....................................................................................................................................... 33 3 | Page Introduction This document compliments the December 2020 DUR report, Newer Oral Antipsychotics, that reviewed second generation antipsychotics (SGAs*) and their place in therapy, with focus on 3 newer drug moieties. This report describes considerations regarding the SGA long-acting injectable (LAI) and orally disintegrating tablet (ODT) formulations, their place in therapy according to guideline recommendations, potential advantages, and unique features or directions for use. LAI antipsychotics offer the potential for improved adherence with less frequent dosing intervals compared to daily oral regimens. These agents must be administered directly by a healthcare provider. The 8 available LAI SGA products are shown in Table 1; all are intramuscular (IM) injections except the subcutaneous product, Perseris. Each LAI SGA is approved for use in schizophrenia. Additionally, Invega Sustenna is approved for schizoaffective disorder; and Abilify Maintena and Risperdal Consta are approved for bipolar I disorder.1-8 None are FDA labeled for use in the pediatric population. Labeling recommendations for initiation of LAI therapy vary. Invega Trinza is indicated for patients who have received at least 4 months of Invega Sustenna therapy. For other LAIs, patients should have tolerated the corresponding oral antipsychotic prior to initiation (or risperidone for Invega Sustenna). Supplementation with an oral antipsychotic is required during the initiation of Abilify Maintena, Aristada, and Risperdal Consta. Aristada Initio is used as a single loading dose for initiation of Aristada, or as a single supplementation dose following a missed Aristada dose. Table 1. Long-Acting Injectable SGAs, FDA Indicated Disorders 1-8, a LAI Product (administration interval) Aripiprazole Aripiprazole Olanzapine Paliperidone palmitate Risperidone lauroxil pamoate Abilify Aristada Zyprexa Invega Invega Risperdal Perseris Maintena (monthly – Relprevv Sustenna Trinzac Consta (monthly) (monthly) 2 months) (2-4 weeks) (monthly) (3 months) (2 weeks) Aristada Initiob Bipolar I disorder X X Schizophrenia X X X X Xd X X Schizoaffective X disorder a Per labeling, Abilify Maintena has not been studied in patients 18 years or younger, and the other LAIs have not been established in patients less than 18 years of age. b Aristada Initio is only to be used as a single dose, as part of the loading dose phase for initiation of Aristada or as a single supplementation dose in the event of a missed dose of Aristada. c Invega Trinza is for patients who stabilized onto at least 4 months of Invega Sustenna. d Prescribing information recommends against use in the pediatric population. Four ODT antipsychotics are available as shown in Table 2. These formulations were developed to increase usability in patients with difficulty swallowing tablets. Experts note that the ODT formulation may also help circumvent discreet non-compliance (“cheeking”).9 The ODT antipsychotics have the same indications as their conventional-tablet counterpart but are quickly dissolved once placed on the * For this report, we will use the terminology of SGA, with third generation antipsychotics included among SGAs. 4 | Page tongue— usually dissolved within 1 minute—and the dissolution contents can be more easily swallowed without liquid. Aside from other solid dosage forms, 3 of these ODT drug moieties are also available as oral solutions (aripiprazole generic solution, clozapine as a brand product [Versacloz], and risperidone generic solution), while olanzapine is unavailable as an oral solution. Table 2. ODT Antipsychotics, FDA Indicated Disorders10-15 Aripiprazole Clozapine Olanzapine Risperidone ODT ODT ODT ODT Zyprexa Zydis Generic Generic Generic and Generic Bipolar I disorder (acute X X (also for X treatment for manic/mixed maintenance episodes) treatment) Schizophrenia X X (for treatment resistant X X (and Schizoaffective disorder for disease,
Load more

Recommended publications
  • Adverse Reactions to Hallucinogenic Drugs. 1Rnstttutton National Test
    DOCUMENT RESUME ED 034 696 SE 007 743 AUTROP Meyer, Roger E. , Fd. TITLE Adverse Reactions to Hallucinogenic Drugs. 1rNSTTTUTTON National Test. of Mental Health (DHEW), Bethesda, Md. PUB DATP Sep 67 NOTE 118p.; Conference held at the National Institute of Mental Health, Chevy Chase, Maryland, September 29, 1967 AVATLABLE FROM Superintendent of Documents, Government Printing Office, Washington, D. C. 20402 ($1.25). FDPS PRICE FDPS Price MFc0.50 HC Not Available from EDRS. DESCPTPTOPS Conference Reports, *Drug Abuse, Health Education, *Lysergic Acid Diethylamide, *Medical Research, *Mental Health IDENTIFIEPS Hallucinogenic Drugs ABSTPACT This reports a conference of psychologists, psychiatrists, geneticists and others concerned with the biological and psychological effects of lysergic acid diethylamide and other hallucinogenic drugs. Clinical data are presented on adverse drug reactions. The difficulty of determining the causes of adverse reactions is discussed, as are different methods of therapy. Data are also presented on the psychological and physiolcgical effects of L.S.D. given as a treatment under controlled medical conditions. Possible genetic effects of L.S.D. and other drugs are discussed on the basis of data from laboratory animals and humans. Also discussed are needs for futher research. The necessity to aviod scare techniques in disseminating information about drugs is emphasized. An aprentlix includes seven background papers reprinted from professional journals, and a bibliography of current articles on the possible genetic effects of drugs. (EB) National Clearinghouse for Mental Health Information VA-w. Alb alb !bAm I.S. MOMS Of NAM MON tMAN IONE Of NMI 105 NUNN NU IN WINES UAWAS RCM NIN 01 NUN N ONMININI 01011110 0.
    [Show full text]
  • Amisulpride Tablets I.P. SOLIAN® THERAPEUTIC CATEGORY Anti-Psychotic COMPOSITION Solian® 50 /100 /200 /400 Each Uncoated Tablet Contains Amisulpride IP
    For the use only of a Registered Medical Practitioner (Psychiatrist) or a Hospital or a Laboratory Abridged Prescribing Information Amisulpride tablets I.P. SOLIAN® THERAPEUTIC CATEGORY Anti-psychotic COMPOSITION Solian® 50 /100 /200 /400 Each uncoated tablet contains Amisulpride IP. 50mg / 100mg / 200mg Each film coated tablet contains Amisulpride IP 400mg. THERAPEUTIC INDICATIONS Treatment of acute and chronic schizophrenic disorders, in which positive symptoms (such as delusions, hallucinations, and thought disorders) and/or negative symptoms (such as blunted affect, emotional and social withdrawal) are prominent, including patients characterised by predominant negative symptoms. DOSAGE AND ADMINISTRATION For acute psychotic episodes, oral doses between 400 and 800 mg/d are recommended. Doses above 1200 mg/d should not be used. For patients with mixed positive and negative symptoms, doses should be adjusted to obtain optimal control of positive symptoms. Maintenance treatment should be established individually with the minimally effective dose. For patients characterised by predominant negative symptoms, oral doses between 50 mg/d and 300 mg/d are recommended. Doses should be adjusted individually. Solian® can be administered once daily at oral doses up to 300 mg, higher doses should be administered bid. The Minimum effective dose should be used. Caution in elderly. Renal & Hepatic insufficiency: Dose should be reduced. Use of amisulpride from puberty to 18 years is not recommended. SAFETY-RELATED INFORMATION Contraindications: Hypersensitivity to amisulpride or to other ingredients of the product; concomitant prolactin- dependent tumours e.g. pituitary gland prolactinomas and breast cancer; phaeochromocytoma; children up to puberty; lactation; combinations with drugs which could induce torsades de pointes and levodopa.
    [Show full text]
  • Aripiprazole Augmentation of Clomipramine Therapy In
    Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2016;29:167-172 Case Report / Olgu Sunumu DOI: 10.5350/DAJPN2016290209 Aripiprazole Augmentation Filiz Izci1, Murat Yalcin2, Sumeyye Yasemin Kurtulus Calli2, of Clomipramine Therapy in Yagmur Sever3, Rabia Bilici3 1Istanbul Bilim University, Faculty of Medicine, Treatment-Resistant Department of Psychiatry, Istanbul - Turkey 2Kocaeli Derince Training and Research Hospital, Department of Psychiatry, Kocaeli - Turkey Obsessive-Compulsive 3Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Istanbul - Turkey Disorder: Case Series ABSTRACT Aripiprazole augmentation of clomipramine therapy in treatment-resistant obsessive-compulsive disorder: case series Obsessive-compulsive disorder (OCD) is a chronic disorder characterized by recurrent intrusive thoughts and repetitive rituals, causing significant distress and functional loss. Studies show evidence about serotonergic and dopaminergic mechanisms in neuropathogenesis of OCD. Selective serotonin re-uptake inhibitors (SSRI) are considered as first-line treatment in OCDs, but treatment resistance may occur in 40-60% of cases treated with SSRIs. Augmentation of antidepressants with atypical antipsychotics is an important treatment option in treatment-resistant patients with OCD. In this article, we aimed to present five OCD cases with treatment-resistance in which we obtained good outcomes, with addition of aripiprazole 10-30mg per day to clomipramine therapy. Address reprint requests to / Yazışma adresi:
    [Show full text]
  • SAFETY of the ELECTROCONVULSIVE THERAPY and AMISULPRIDE COMBINATION Rozália Takács1, Zsolt Iványi2, Gabor S
    Psychiatria Danubina, 2013; Vol. 25, No. 1, pp 76-79 Brief report © Medicinska naklada - Zagreb, Croatia SAFETY OF THE ELECTROCONVULSIVE THERAPY AND AMISULPRIDE COMBINATION Rozália Takács1, Zsolt Iványi2, Gabor S. Ungvari3, 4 & Gábor Gazdag1,5 1Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary 2 Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary 3University of Notre Dame, Australia 4Marian Centre, Perth, Australia 5Consultation–Liaison Psychiatric Service, Szent István and Szent László Hospitals, Budapest, Hungary received: 21.10.2011; revised: 16.1.2012; accepted: 2.12.2012 SUMMARY Background: Electroconvulsive therapy is frequently considered when pharmacotherapy is ineffective. In such cases the combination of the two treatment modalities are commonly used. Amisulpiride, a second generation antipsychotic drug is used in the treatment of schizophrenia and psychotic depression. When amisulpiride is ineffective as a monotherapy, combination with ECT could be an option to enhance its efficacy. To the best of our knowledge, to date there have been no data about the safety of this combination. Subjects and methods: Medical notes of all patients who were given ECT while on amisulpiride were selected from the archives of the Department of Psychiatry, Semmelweis University Medical School, Budapest, covering a 10-year period. A randomly selected matched control group was formed from patients who underwent ECT but were not taking amisulpiride. Patients in both groups also received a variety of psychotropic drugs other than amisulpide. Side effects were compared between the two groups of patients. Results: Twenty patients received amisulpride with ECT. The most common side effects were headache, hypertension, tachycardia, nausea, dizziness, confusion, psychomotor agitation, sialorrhea, and prolonged seizure activity.
    [Show full text]
  • Antipsychotics
    © Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 | Fax 503-947-1119 Class Update with New Drug Evaluations: Antipsychotics Date of Review: May 2016 End Date of Literature Search: February 2016 New Drugs: brexpiprazole Brand Names (Manufacturer): Rexulti® (Otsuka) cariprazine Vraylar™ (Actavis) Dossiers Received: yes PDL Classes: Antipsychotics, First generation Antipsychotics, Second generation Antipsychotics, Parenteral Current Status of PDL Class: See Appendix 1. Purpose for Class Update: Several new antipsychotic drug products have been approved by the U.S. Food and Drug Administration since these drug classes were last reviewed by the Oregon Health Plan (OHP) Pharmacy and Therapeutics Committee. Research Questions: 1. Is there new comparative evidence of meaningful difference in efficacy or effectiveness outcomes for schizophrenia, bipolar mania or major depressive disorders (MDD) between oral antipsychotic agents (first‐ or second‐generation) or between parenteral antipsychotic agents (first‐ or second‐generation)? 2. Is there new comparative evidence of meaningful difference in harms between oral antipsychotic agents (first‐ or second‐generation) or between parenteral antipsychotic agents (first‐ or second‐generation)? 3. Is there new comparative evidence of meaningful difference in effectiveness or harms in certain subpopulations based on demographic characteristics? Conclusions: There is insufficient evidence of clinically meaningful differences between antipsychotic agents in efficacy or effectiveness or harms between antipsychotic agents for schizophrenia, bipolar mania or MDD. There is insufficient evidence to determine if brexpiprazole and cariprazine offer superior efficacy or safety to other antipsychotic agents for schizophrenia. There is insufficient evidence to determine if brexpiprazole offers superior efficacy or safety to other antipsychotic agents for MDD.
    [Show full text]
  • Pharmacogenetic Studies Investigating the Adverse Effects of Antipsychotics
    online © ML Comm 0REVIEW ARTICLE0 Psychiatry Investig 2007;4:66-75 Print ISSN 1738-3684 / On-line ISSN 1976-3026 Pharmacogenetic Studies Investigating the Adverse Effects of Antipsychotics Heon-Jeong Lee, MD, PhD The pharmacogenetic study of antipsychotics has been developed along with the develop- Department of Psychiatry, ment of general techniques of genetic analysis. Because there are no significant differences Division of Brain Korea in the clinical efficacy of the various antipsychotics, it is important to prevent the adverse 21 for Biomedical Science, Korea University College of Medicine, effects of antipsychotics. Therefore, pharmacogenetic studies concerning antipsychotics have Seoul, Korea been primarily focused on their adverse effects. The most significant finding of the previous studies is the association between drug effects and drug metabolic polymorphisms, mainly in the cytochrome P450 (CYP) genes. Patients with genetically determined to be CYP poor metabolizers (PMs) may require lower doses of antipsychotic medications. On the other hand, CYP ultrarapid matabolizers (UMs) will need an increased dosage in order to obtain a therapeutic response. Genetic variations in the dopamine and serotonin receptor genes have been reported to be associated with the adverse effects of antipsychotics, reflecting the affinities that most antipsychotics have for these receptors. In particular, there is evidence to suggest an association between dopamine 2 receptor polymorphisms and a dopamine 3 receptor polymorphism and antipsychotic-induced tardive dyskinesia. Several studies were recently performed to determine the genetic susceptibility to antipsychotic-induced weight gain and metabolic syndrome. Adrenergic 2a receptor, leptin gene, and serotonin 2C receptor gene variants have been reported to be associated with drug-induced weight gain.
    [Show full text]
  • Photodegradation Assessment of Amisulpride, Doxepin, Haloperidol, Risperidone, Venlafaxine, and Zopiclone in Bulk Drug and in the Presence of Excipients
    Monatshefte für Chemie - Chemical Monthly (2020) 151:483–493 https://doi.org/10.1007/s00706-020-02570-0 ORIGINAL PAPER Photodegradation assessment of amisulpride, doxepin, haloperidol, risperidone, venlafaxine, and zopiclone in bulk drug and in the presence of excipients Anna Maślanka1 · Paweł Żmudzki2 · Marek Szlósarczyk1 · Przemysław Talik1 · Urszula Hubicka1 Received: 9 October 2019 / Accepted: 25 February 2020 / Published online: 8 April 2020 © The Author(s) 2020 Abstract Photostability of amisulpride, doxepin, haloperidol, risperidone, venlafaxine, and zopiclone in APIs and powdered tablets during exposure to UVA irradiation was studied. In order to evaluate the photodegradation process an ultrahigh performance liquid chromatography method coupled with tandem mass spectrometry (UHPLC-MS/MS) was developed and validated. It was found that the photodegradation of the studied compounds depends on the type of drug and co-existing excipients. Dif- ferent percentage of photodegradation of the studied drugs was observed, and therefore amisulpride decomposed at 2.63% in bulk drug and at 5.74% in pharmaceutical preparation, doxepin: 29% and 72.38%, haloperidol: 3.71% and 26.20%, risp- eridone: 7.13% and 12.86%, venlafaxine: 38.59% and 4.22%, zopiclone: 18.62% and 31.42% respectively, after 114 days of UVA irradiation. In addition, kinetic evaluation of the photodegradation process was performed by determining the order of reaction, reaction rate constant k and time t0.1 and t0.5. The photodegradation products of studied drugs were identifed, and their fragmentation pathways, derived from MS/MS data, were proposed. The photostability testing is an integral part of the drug stability assessment to ensure quality, efcacy and safety of the formulated products during manufacturing process, storage as well as normal use.
    [Show full text]
  • Pharmaceutical Appendix to the Tariff Schedule 2
    Harmonized Tariff Schedule of the United States (2007) (Rev. 2) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2007) (Rev. 2) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. ABACAVIR 136470-78-5 ACIDUM LIDADRONICUM 63132-38-7 ABAFUNGIN 129639-79-8 ACIDUM SALCAPROZICUM 183990-46-7 ABAMECTIN 65195-55-3 ACIDUM SALCLOBUZICUM 387825-03-8 ABANOQUIL 90402-40-7 ACIFRAN 72420-38-3 ABAPERIDONUM 183849-43-6 ACIPIMOX 51037-30-0 ABARELIX 183552-38-7 ACITAZANOLAST 114607-46-4 ABATACEPTUM 332348-12-6 ACITEMATE 101197-99-3 ABCIXIMAB 143653-53-6 ACITRETIN 55079-83-9 ABECARNIL 111841-85-1 ACIVICIN 42228-92-2 ABETIMUSUM 167362-48-3 ACLANTATE 39633-62-0 ABIRATERONE 154229-19-3 ACLARUBICIN 57576-44-0 ABITESARTAN 137882-98-5 ACLATONIUM NAPADISILATE 55077-30-0 ABLUKAST 96566-25-5 ACODAZOLE 79152-85-5 ABRINEURINUM 178535-93-8 ACOLBIFENUM 182167-02-8 ABUNIDAZOLE 91017-58-2 ACONIAZIDE 13410-86-1 ACADESINE 2627-69-2 ACOTIAMIDUM 185106-16-5 ACAMPROSATE 77337-76-9
    [Show full text]
  • Studies with Lysergic Acid Diethylamide in Regressed Schizophrenics
    CHAPTER 15 _ Studies with Lysergic Acid Diethylamide in Regressed Schizophrenics By FREDERICK B. CHARAT AN, M.D. OF THE MANY studies carried out with lysergic acid diethylamide in the last 15 years, relatively few have dealt with regressed schizophrenics. Most workers have used comparatively small doses of LSD. Some gave up to 600 gamma orally. Others reported the effects of up to 500 gamma intra- muscularly, 180 gamma intravenously and 60 gamma intrathecally in small series of cases. Several investigators agreed that in chronic schizophrenics higher doses of LSD than those administered to undeteriorated schizo- phrenics and nonpsychotics have been required to produce psychic effects. Apart from the slight response of chronic schizophrenics to doses of LSD which lead to marked and characteristic effects in other subjects, tolerance to the drug seems to develop in as brief a period as three days. These differences in response to LSD pose some interesting problems. Is the lack of response in chronic schizophrenics merely an apparent one caused by their inability to communicate their inner experiences? Is it due to the development of some immune state connected with biochemical alter- ations produced during the psychosis? Is it the reflection of a metabolic difference between schizophrenics and non-schizophrenics? May it be a general manifestation of schizophrenic underresponsiveness to virtually any stress, once the chronic stagnant phase of the psychosis has been reached? Clear answers to all these questions cannot yet be given. The present investi- gation was undertaken to examine further the responses of chronic schizo- phrenics to large doses of LSD and also to observe the effect of other drugs upon this response.
    [Show full text]
  • Perphenazine-151548-PI.Pdf
    PRESCRIBING INFORMATION PERPHENAZINE Perphenazine Tablets USP 2 mg , 4 mg, 8mg, and 16 mg Antipsychotic/Antiemetic AA Pharma Inc. DATE OF REVISION: April 12, 2012 1165 Creditsone Road, Unit #1 Vaughan, Ontario L4K 4N7 Control Number: 151548 PRESCRIBING INFORMATION PERPHENAZINE Perphenazine Tablets USP 2 mg, 4 mg, 8 mg and 16 mg THERAPEUTIC CLASSIFICATION Antipsychotic/Antiemetic ACTIONS AND CLINICAL PHARMACOLOGY Perphenazine is a piperazine phenothiazine derivative with antipsychotic, antiemetic and weak sedative activity. Perphenazine has actions similar to those of other phenothiazine derivatives but appears to be less sedating and to have a weak propensity for causing hypotension or potentiating the effects of CNS depressants and anesthetics. However, it produces a high incidence of extrapyramidal reactions. Perphenazine is well absorbed from the gastrointestinal tract. Onset of action following oral administration is 30 to 40 minutes. Duration of action is 3 to 4 hours. Perphenazine distributes to most body tissues with high concentrations being distributed into liver and spleen. Perphenazine enters the enterohepatic circulation and is excreted chiefly in the feces. INDICATIONS AND CLINICAL USE Perphenazine is indicated in the management of manifestations of psychotic disorders. It is also effective in controlling nausea and vomiting due to stimulation of the chemoreceptor trigger zone. 1 Perphenazine has not been shown effective for the management of behavioral complications in patients with mental retardation. CONTRAINDICATIONS Should not be administered in the presence of circulatory collapse, altered states of consciousness or comatose states, particularly when these are due to intoxication with central depressant drugs (alcohol, hypnotics, narcotics). It is contraindicated in severely depressed patients, in the presence of blood dyscrasias, liver disease, renal insufficiency, pheochromocytoma, or in patients with severe cardiovascular disorders or a history of hypersensitivity to phenothiazine derivatives.
    [Show full text]
  • NORTHERN ILLINOIS UNIVERSITY Schizophrenia and LSD Experiences
    NORTHERN ILLINOIS UNIVERSITY • Schizophrenia and LSD Experiences: More Similar Than Once Thought A Thesis Submitted to the University Honors Program In Partial Fulfillment of the Requirements of the Baccalaureate Degree With Upper Division Honors Department Of Leadership, Educational Psychology, and Foundations By: Melissa Hoey DeKalb, Illinois May 8, 2004 University Honors Program Capstone Approval Page Capstone Title: (print or type): Schizophrenia and LSD Experiences: More Similar Than Once Thought Student Name (print of type): Melissa Hoey Faculty Supervisor (print or type): Dr. Thomas Roberts Faculty Approval Signature: Department of (print or type): Department of Leadership, Educational Psychology, and Foundations Date of Approval (print or type): HONORS THESIS ABSTRACT THESIS SUBMISSION FORM AUTHOR: Melissa Hoey THESIS TITLE: Schizophrenia and LSD Experiences: More Similar Than Once Thought ADVISOR: Dr. Thomas Roberts ADVISOR'S DEPT: Department of Leadership, Educational Psychology, and Foundations DISCIPLINE: Psychology YEAR: 2004 PAGE LENGTH: 33 pages BIBLIOGRAPHY: yes ILLUSTRATED: no PUBLISHED (Yes or No): no LIST PUBLICATION: NIA COPIES AVAILABLE (HARD COPY, MICROFILM, DISKETTE): Hard Copy ABSTRACT (100-200 WORDS): Schizophrenia and LSD have similarities not only in the neurotransmitters they activate specifically dopamine, serotonin, and glutamate; but, also, in hallucinations and psychosis. Because LSD use was criminalized in the 1960s, today limited research is being conducted on humans using LSD. If, in fact, LSD does "model psychosis", it should provide an understanding for the disorder schizophrenia; therefore, a research of existing literature was read and analyzed to see if this claim is true. Evidence found similarities in dopamine (D2) receptors, serotonin (5-HT 2A) receptors, and glutamate, but found differences in the types of hallucinations and psychosis LSD users and people with schizophrenia experience.
    [Show full text]
  • Preparation of Metabolites by Chemical Reaction: Conversion of Antipsychotic Phenothiazines to Their Sulfoxides and Tertiary
    396 Journal of Health Science, 50(4) 396–406 (2004) Preparation of Metabolites N-oxides from parent drug could be confirmed when the collisional energy was decreased to 10 eV. 1H- and by Chemical Reaction: 13C-NMR spectral data confirmed the structure of the Conversion of Antipsychotic prepared mianserin N-oxide to be 2-oxide. In conclu- sion, a simple and rapid preparation method for oxide Phenothiazines to their metabolites of phenothiazines and tertiary amino cy- Sulfoxides and Tertiary clic antidepressants available as analytical standards was established. Amino Cyclic Key words —–— metabolite, chemical preparation, ox- Antidepressants ide, phenothiazine, cyclic antidepressants, mass spectros- to their N-Oxide with copy Hydrogen Peroxide Using Titanosilicate INTRODUCTION Catalyst The identification and quantification of drugs Akira Ogamo* and Mariko Fukumoto ingested into human bodies require comprehensive information covering the target drugs themselves and School of Pharmaceutical Sciences, Kitasato University, their metabolites. To carry out a quantitative analy- Shirokane 5–9–1, Minato-ku, Tokyo 108–8641, Japan sis, the standard substances of metabolites are es- (Received March 5, 2004; Accepted April 11, 2004) sential. Some important metabolites can be obtained as commercial products, but many metabolites, es- The aim of this study was to establish a prepara- pecially those of new drugs, are difficult to obtain tion method needed to analyze the metabolites of an as standard samples. These problems have been analytical procedure for antipsychotic phenothiazines solved by using experimental animals or isolated and tertiary amino cyclic antidepressants by chemical enzyme systems originating from biological mate- reaction. These drugs were oxidized to their sulfoxide rials.
    [Show full text]